HomeMy WebLinkAbout1106 Oak Leaf Ct - Applications/Reroof - 10/31/2011City Of Planning, Development & Transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins, CO 80524
Phone 970-41616-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑Electrical Alteration (not servpe change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement [ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information
Application # 9 VS
For office use only j
on the application. Incomplete apple ation will not be accepted.
i� 1. Date t
Job Site Address (required) Value of Construction (labor, materials, profit)
t106 D.,.k 1,a,� C_V $
Property Owner Name Address
City/State` Zip
Phone
V -
LX. C 1 A 92
5' q L
Applicant Name Address
City/State Zip
Phone
i
Contractor Lic #J Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here ❑ Report
sales tax number is required by allconbactors.
Are you paying with your trust account?
❑ Yes okfo
Is this a residential or ercial project? Residential ❑Commercial
If residential, is it: co Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you will need an asbestos assessment to submit with this application.
of
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: 1 1
Print Name: i Signature /.(Q��AU r Date 10. I Z